Updated: Jan 12, 2022
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It is not uncommon to hear someone chuckle and say “Sorry, I’m a little OCD” when they carefully rearrange something on their table. However, Obsessive Compulsive Disorder (OCD) encompasses something more severe than just having to arrange something neatly.
OCD is one of the top mental health disorders amongst Singaporeans. It actually affects a huge chunk of the sufferer’s life and can disrupt his or her life to a large extent.
What is OCD?
Obsessive Compulsive Disorder (OCD) is a mental health disorder involving obsession, compulsion or both.
Obsession is described as having recurring and unwanted thoughts, ideas or sensations while compulsion is the urge to do something repetitively due to obsessions or certain rules. 
OCD can cause severe distress or social dysfunction in the sufferer.
What are the causes of OCD?
Currently, the exact causes of OCD are not fully understood yet. However, there have been genetic and environmental causes that are linked to OCD.
Scientists have found that there is a strong link between heredity and OCD. Studies have reported that the risk of developing OCD is much higher if a first-degree family member (parents, children and siblings) suffers from OCD.
Serotonin, dopamine and glutamate are key neurotransmitters (chemicals that help to relay information) and have been known to be linked to OCD symptoms. A decrease or insensitivity in these neurotransmitters has been observed in patients with OCD.
Researchers believe that OCD can be developed, especially under stress, when the person learns to avoid situations or objects that they associate fear with. The person then performs certain acts to help reduce the anxiety that he or she may feel while encountering these situations.
There has been growing evidence to show that traumatic life events can be linked to OCD. The onset of OCD can occur to people after they undergo a stressful or traumatic life event, such as childbirth, serious illness or a traumatic brain injury.
What are the types of OCD?
There are 6 types of OCD, although they are not distinctive from each other, and often overlap with one another. 
This type of OCD causes the sufferer to have the need to check something over and over due to a fear of possible harm to oneself or others. The sufferer tends to carry out checks several times or even hundreds of times and can last for hours.
Common things that a sufferer would tend to check include if a door is locked, fire alarms and checking their body for signs of illness.
This is the fear of being dirty, and that contamination would affect the sufferer or their loved ones. The sufferer would tend to wash and clean themselves until they feel that they are clean. They may also avoid a place, person or object if they had experienced a contamination fear previously. Common contamination worries include public toilets, shaking hands and hospitals.
Mental contamination is similar to physical contamination but occurs when the sufferer feels like ‘dirt’ due to bad treatment physically or mentally. This causes the sufferer to obsessively or compulsively try to wash the ‘dirt’ away by showering until they feel ‘clean’ again.
Hoarding used to be classified under OCD but has now been reclassified as a distinctive disorder in DSM-5. Sufferers of this type of OCD have extreme difficulties in discarding old, worn-out or useless items. This is due to a fear that they may lose something that may be needed one day, or have emotional sentiments to them.
This type of OCD causes the sufferer to have obsessional thoughts that are usually disturbing or horrific in nature. Examples are thoughts of causing violence or sexual assault to loved ones. Such thoughts are usually non-voluntary.
Symmetry and orderliness
This is the obsession of having everything lining up symmetrically. The sufferer can spend hours to ensure that everything is placed right to prevent discomfort. Examples include having pictures, books and clothes arranged in a certain way.
What are the symptoms of OCD?
Some symptoms of OCD include: 
Arranging items in a very specific way
Bathing, cleaning or washing hands frequently & repetitively
Checking certain things repeatedly
Constantly checking that you have not done anyone harm
Counting repeatedly or saying certain words or prayers while doing things
Eating food in a specific manner
Refusing to shake hands or touch certain objects which people touch a lot e.g. door handles
Performing tasks a certain number of times e.g. closing a door five times
Dermatitis due to frequent hand-washing
Skin lesions from picking at skin
Hair loss or bald spots from hair pulling
Impulses to shout vulgarities in inappropriate situations
People suffering from OCD may also have brief, sudden and repetitive movements known as ‘tics’, such as:
Blinking their eyes
Jerking their head
Shrugging their shoulders
Sniffling their nose
What are common OCD thoughts?
People who suffer from OCD typically have some common thoughts that run through their minds, such as: 
Aggressive or disturbing thoughts e.g. harming one’s family member
Worries about unintentionally hurting others e.g. running into a pedestrian
Constant worry about catching a disease and/or infecting others with your germs
Disturbing sexual and/or religious imagery that may include sexual assault
Fear of contamination with environmental toxins such as radioactivity
Fears of forgetting or losing something
Strong need to arrange something until they feel right
Fear that something horrible would happen to a loved one
What tests are there to diagnose OCD in Singapore?
Getting diagnosed with OCD in Singapore involves a physical exam, a psychological evaluation and meeting criteria in DSM-5. 
A physical exam is done to rule out the possibility of other medical conditions or complications that may have been causing OCD symptoms. Laboratory tests may also be ordered to be sure.
Your doctor will talk to you about how you feel, think and behave to help in the evaluation process. Your doctor may also talk to your family members or close friends to get to know about your condition better. If you suspect you may have OCD, it is also good to track the symptoms (e.g. how long has it been going on) as it may help your doctor in his or her evaluation.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a screening tool used by doctors to help in diagnosing a patient with various mental disorders, including OCD.
To be diagnosed with OCD, the patient needs to have the presence of obsession, compulsion or both, which are:
Other criteria are:
Obsession or compulsion are time-consuming (more than 1 hour a day). They cause clinically significant distress or impairment in social, occupational or other important parts of functioning.
The disturbance is not better explained by symptoms of another mental disorder (e.g. excessive worries due to generalised anxiety disorder)
The disturbance is not due to a direct physiological effect of a substance (e.g. drug abuse) or a general medical condition
What are treatments for OCD in Singapore?
There are a series of treatment options for OCD in Singapore, ranging from medication to therapy.
SSRIs prevent the reabsorption of serotonin, which is a neurotransmitter responsible for communication between nerves. Serotonin is also involved in many types of behaviour and experiences. Although its exact mechanisms are not yet known, serotonin has shown to be effective in improving the symptoms of OCD.
Other commonly prescribed medications for OCD include tricyclic antidepressants, known as Clomipramine. Tricyclic antidepressants work by blocking the reuptake of serotonin and norepinephrine, and have been shown to be effective in treating OCD.
Psychotherapy involves talking to a psychiatrist, psychologist or mental health provider about your conditions. It is aimed to help you learn about your condition, moods, feelings, thoughts and behaviour.
Cognitive behavioural therapy (CBT) is one of the common psychotherapy methods used to treat OCD. During CBT, a therapist helps you to take a closer look at your thoughts and emotions, and how they can affect one another. You will then learn to stop negative thoughts and adopt healthier ways of thinking.
Exposure and Response Prevention therapy (ERP) is another method that is shown to reduce OCD symptoms. During ERP, the patient is exposed to a stimulus that triggers his or her OCD and is emotionally supported by the therapist as they work to avoid responding to the stimulus. Eventually, the patient is able to prevent themselves from reacting in an OCD manner and are more successful in avoiding the anxiety-inducing thoughts and behaviours.
Habit Reversal training helps the patient realise how and when their OCD habit or tics may occur, allowing them to intervene and prevent them from making a change. However, habit reversal training usually takes time, diligent practice as well as loads of patience.
Deep Transcranial Magnetic Stimulation
Deep Transcranial Magnetic Stimulation (Deep TMS) has been shown to effectively and safely reduce symptoms of OCD. 
This treatment utilises magnetic fields emitted from a H7-coil to reach broader and deeper regions in the brain. This is said to be able to regulate the neural activities that are associated with OCD.
Can OCD be cured? Can OCD be cured without medication?
OCD cannot be cured permanently, and its symptoms tend to come and go. However, it is possible to treat and properly manage your OCD, so that it does not get in the way of your daily life.
Generally, when a patient experiences high-stress points in their lives, their OCD symptoms tend to show strongly. At low-stress points, a patient’s OCD symptoms tend to be much lesser, or not shown. As such, doctors may recommend staying stress-free to help manage your OCD better.
OCD can be treated without medication. CBT is known to receive good responses from OCD patients. CBT helps patients learn how to navigate their experiences differently and change the way they respond to their thoughts, feelings and sensations.
What are conditions related to OCD?
There are a few medical conditions that are related to OCD, such as: 
Body Dysmorphic Disorder:
A mental health disorder whereby the sufferer cannot stop thinking about perceived flaws in his or her physical appearance, although it may be minor, or is not seen by others.
A mental health disorder whereby the sufferer excessively keeps or collects items that others view as useless.
Trichotillomania (Hair-pulling disorder):
A mental health disorder whereby the sufferer cannot resist pulling out the urge to pull out their hair.
Excoriation (skin-picking) disorder:
A mental health disorder whereby the sufferer repeatedly picks at his or her skin, causing skin lesions to form.
A mental health disorder whereby the sufferer has an unrealistic fear that they have a serious medical condition or are at high risk of falling sick.
Olfactory reference syndrome:
A mental health disorder whereby the sufferer believes that he or she emits an unpleasant body odour.
A neurological disorder whereby the sufferer has sudden, repetitive, rapid and unwanted movements or vocal sounds known as tics.
What does an OCD attack feel like?
An OCD attack causes the sufferer to be occupied by the obsessions and compulsions. The sufferer usually spends a large amount of time thinking about the obsession and acting upon the compulsions. This takes up a large portion of his or her time. Depending on the type of obsession and compulsion, this can result in a disruption of the sufferer’s life, causing them to struggle at work or at school.
During an OCD attack, sufferers may also suffer from a panic attack, or symptoms associated with a panic attack such as sweaty palms, rapid heartbeat and dizziness. This can last for a few minutes or even hours. 
How does OCD affect relationships?
Other than one’s personal life, OCD can also affect relationships that the sufferer has with his or her coworkers, friends and family. 
For example, having obsessions about the cleanliness of others may result in the inability to build or maintain relationships, especially an intimate relationship with your partner. This can lead to dissatisfaction in the relationship.
Those with OCD may also be in a state of uncertainty and require constant assurances, which can be overwhelming for those around their side.
However, it takes some understanding from those around to help deal with OCD, which can help improve the relationships. Some examples include:
Try not to take it personally when they are having a bad day.
Your patience means everything to them.
Getting involved in their treatment could help improve the relationship.
When should I see a doctor for my OCD?
You should see a doctor for your OCD when you find that your obsessions and compulsions are interfering with your ability to lead a normal life. Getting an early diagnosis means that help or treatment can be rendered earlier, which helps you get the condition under control faster.
Are there any alternative treatments for OCD?
There are certain alternative treatments that are said to be able to help in the management of OCD such as:
St John’s wort: St John’s wort is said to reduce symptoms of OCD as effectively as during a SSRI treatment.
5-HTP and inositol: These herbs work to regulate the glutamatergic and serotonergic pathways which are said to be involved in OCD, hence reducing symptoms of OCD.
Yoga: Doing yoga can help reduce stress and improve regulations of OCD of up to 50%.
How much do OCD treatments cost in Singapore? Are they Medisave claimable?
The table below shows the estimated cost of OCD treatments per month in Singapore. Do note that prices may vary amongst the various polyclinics or government hospitals. Choosing to visit a private clinic or private hospital will also tend to be more expensive.
Subsidised cost per month
Unsubsidised cost per month
Therapy and Counselling
$240 for 4 sessions
$800 for 4 sessions
Inpatient psychiatric treatments for depression in Singapore are claimable by Medisave (up to $150/day and capped at $5000/year). You may claim up to $100/day under Medishield Life.
All in all, OCD has the potential to debilitate the sufferer’s life. An early diagnosis can help to put the condition under control. Of course, it is also important for those around the sufferer to be as patient as they can and offer encouragement as much as possible.
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This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.
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